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This month, we feature Allen Bennett King, MD, CDE, FACP, FACE, assistant clinical professor at the University of California Natividad Medical Center. Dr. King is the cofounder and medical director of the Diabetes Care Center in Salinas, California.
I don’t believe there are many MDs who are also CDEs—like yourself. Why did you take the time to obtain the CDE credential?
I jokingly say, “I receive no respect from CDEs when lecturing CDEs if I don’t myself have a CDE.” Really, I feel that education is the cornerstone of diabetes care. As a physician specializing in diabetes, I should respect its importance by taking the time for the certifying examination.
What is the most important thing you have learned from your patients with diabetes?
In medical school, doctors are taught two things about patient relationships: control and disassociation. We are taught that we are responsible for any bad outcome. This is taught by the interns to the students, the residents to the interns and the attending physicians to the residents.
Diabetes care is different. Ninety-five percent of all care is done by the patient and not by the physician-educator. This care is based on the patient’s self-awareness (such as checking blood glucose), education and self-empowerment. Self-empowerment is the cornerstone of this triangle and can only be done by the patient with the support of the healthcare team. We don’t control patients; in fact, we can’t even control ourselves most of the time.
In the first few days of medical school, we dissect a human body, which we call a “cadaver.” To survive this traumatic step, we learn to disassociate from the patients and to treat them in a dispassionate manner so that we can be “rational” in our approach.
What patients have taught me is that they can control their own diabetes if given the right tools and emotional support. They have taught me to recognize depression and denial and to nip it in the bud. Also, a patient can be both a friend and a patient. They taught me the difference between empathy and sympathy. Empathy can occur without losing your clinical, logical approach. While I have stressed compliance and adherence, adherence is what the patients indicate is the best approach.
What does it take to be a good diabetes educator?
We assume that the educator is educated and is a CDE. Beyond that, the educator must listen to the patient. Listening to what the patient says but also what they don’t say. It’s key to listen to how they say it, noting expression and body language.
Have empathy with patients to realize what great changes they may have to make in their lifestyle to accommodate their disease management. Realize that one treatment protocol is not for all patients. Some patients may make all the changes necessary with one education session. Some may require many. Some may not change at all. With the latter, you may not change them to meet your own goals for them, but at least you can be their friend and hope that over time they may change.
How is the Diabetes Care Center in Salinas staffed, and what is its focus?
Dana Armstrong, RD, CDE, and I founded the Diabetes Care Center in 1998 in order to provide outpatient treatment, education and research for patients in our area and throughout the nation. Our focus, first and foremost, is compassionate and practical patient care, utilizing the latest diagnostic and treatment programs by our staff of physicians and mid-level providers. Our research touches on new and practical applications of glucose-sensing technologies, simplified insulin dosing guides for patients on rapid-acting insulin, new uses of medications for the treatment of type 2 diabetes, an outreach program for primary care physicians’ offices to improve their delivery of diabetes care, and testing of new devices.
Could you give your two cents on the problems with reimbursement for education services?
It continues to be the same problem of insurance carriers giving lip service to preventive care but paying little or nothing for education. When a serious health event occurs, which quite possibly could have been avoided, they step up to the pay window and reimburse all providers according to their contracts. This is very disheartening.
Insurance companies pay for coronary artery bypass graphs costing thousands of dollars, but these same insurance companies pay little for the outpatient treatment of diabetes to prevent the coronary disease in the first place, and they pay even less for education. If I could change things, I would encourage many more nurses, pharmacists and dietitians to become CDEs by recruitment campaigns and subsidized educational programs paid for by pharmaceutical and insurance companies.
What is your impression of diabetes care today?
Diabetes care today is horrible. Primary care physicians who do not have the time, focus, staff or systems for care deliver 90 percent of all care. This is why we push for enlarging the pool of CDEs in our nation.
Some of Dr. King’s publications that help other providers give quality care to diabetes patients
Diabetes Care Center Treatment Guide for Diabetes
King A, Armstrong D, Healy S.
Pocket-sized booklet containing diabetes treatment algorithms. Also has information on hypertension, dyslipidemia, CAD, retinopathy, nephropathy and foot care. Available from the Diabetes Care Center at (831) 769-9355; or send e-mail to gwolfe@diabetescarecenter. com.
The Dosing Card for Rapid-Acting Insulin
Laminated folding card giving carb amounts for patient use. Available from the Diabetes Care Center at (831) 769-9355; or send e-mail to firstname.lastname@example.org.
New Drug Treatments for Diabetes
Armstrong D, King AB.
Lincolnwood, IL: Publications International, Ltd. 2001. Available from Amazon.com.
The Diabetic Bible
Armstrong D, King AB.
Lincolnwood, IL: Publications International, Ltd. 2004. Available from Amazon.com.
Diabetes Health is the essential resource for people living with diabetes- both newly diagnosed and experienced as well as the professionals who care for them. We provide balanced expert news and information on living healthfully with diabetes. Each issue includes cutting-edge editorial coverage of new products, research, treatment options, and meaningful lifestyle issues.